Are Kids with ADD, ADHD, and Other Disorders Overmedicated?

Bestselling author Judith Warner says no.

by Nell Casey

February 23, 2010

In her new book, We’ve Got Issues: Children and Parents in the Age of Medication, Judith Warner, author of the New York Times bestseller Perfect Madness: Motherhood in the Age of Anxiety, explores the myth of the overmedicated child and writes that the rise of mental illness diagnoses in children is not the result of anxious parents seeking treatment for their “normal” kids. Instead, she reports, we are being led to this assumption by a misinformed media and a small group of anti-medication doctors. With compassion and thorough research, Warner portrays another world in which families and doctors are fighting to give struggling children their lives back. – Nell Casey

As you researched the book, how did your preconceived notions about children and medication break down?

My idea for this book was born of observations in my community in Washington, D.C. seeing preschool age children with various conditions going to all kinds of therapies. I’d also heard of older kids taking medication for various problems. It all seemed crazy to me. With the competitive nature of our community and parents trying to perfect their kids, it seemed to me that the two were related. I thought the whole thing was a sign of social pathology.

But when I started working on the book, I found that the experts didn’t necessarily think what I thought. You would find these quotes in the media about, say, ADHD [attention-deficit hyperactivity disorder] being a flavor-of-the-month diagnosis. I realize now there is only a very small minority of doctors who believe this – but they get a lot of press. Overall, most experts say the real problem is under-diagnosis. Also, medication truly helps many children: Twenty years of scientific research have shown, for example, that antidepressant medication, when coupled with cognitive-behavioral therapy, works for 60 to 80 percent of children suffering from depression and anxiety disorders. So I kept shifting my idea for the book; I kept trying to make my original idea hold water.

You’re thinking really changed, though, when you started talking to parents.

Right. I went to a meeting in Silver Spring, Maryland – it was for a group I’d found called “Should I Worry?” It was billed as a meeting for parents who were anxious about their children’s progress and wondering whether they had issues. As it turned out, though, these were parents with children with very serious mental health problems in the public school system; they were desperate to find a life raft. They were using medication for their children because otherwise their children would be locked away. I just started crying in the car on the way home. I felt I had absorbed so much misery of a kind I had never experienced before.

I realized I had to talk to more parents. Once I did, the emotional reality emerged. They had all gone through a long emotionally-wrenching journey with their children. Let’s say ADHD is the most benign of the mental health disorders children can have – it still can have really serious ramifications. I write about one ten-year-old girl who’d been formally diagnosed with ADHD – she sobbed for weeks over the distress she felt in doing her homework and begged her parents to run her over with their car. Her parents remain conflicted about whether to give her medication – they haven’t yet. The situation has completely drained the family.

More often, however, I would hear that medication made families’ lives a lot better. The key here is not whether medication is good or bad but: What did the parents go through? What did the children go through? What was the thought process leading up to their decision to have their children take medication?

What people tend to assume is that kids who are just distracted or jumpy are given medication.

Exactly. When we talk eye-rollingly about badly behaved, fidgety kids, we’re completely missing the reality of what is going on for these families. One woman spoke to me about her nine-year-old boy who was eventually diagnosed with Asperger’s. She didn’t want to believe that anything was wrong with him – she assumed that others were putting out-of-whack expectations on him. But she had to confront the problem when her son’s teacher told her that he’d been banging his head on the ground and repeating back what people were saying, reversing pronouns and repeating lines from movies and TV – all typical ways autistic children speak. The main thing that doesn’t come through in the media coverage of children’s mental health issues is the fact that people are really suffering.

Why do you think the media is invested in promoting an image of parents giving medication to their children when they don’t measure up to their expectations in some way?

For one, I think the media is made up of people like me who share the same prejudices of society at large so, for the most part, they’re just people who haven’t necessarily had the exposure to these issues to know what is going on. Also, the behavior of the pharmaceutical companies has been so bad. It has made for a long string of valid stories about their bad behavior in the press, as in the case of Harvard psychiatry professor Joseph Biederman who, after pioneering aggressively medicating kids, was found to be in the pocket of the drug companies. But this kind of press has also made it easier to conflate what the drug companies are doing, which is basically pushing medication at all costs, with what psychiatrists are doing. Too often, we let the drug companies dictate how we see mental health issues today.

In your opinion, are any children being overmedicated?

There are populations where over-medication is going on. Children on Medicaid, for example, are being given anti-psychotics at a much higher rate than upper-middle-class children. But the press is mainly about upper-middle-class families. I’ve found if you say what everybody already thinks, people will rally to what you’re saying and celebrate it as truth. Too often, we let the drug companies dictate how we see mental health issues today.

The experience of having a child with real mental health issues – as opposed to regular everyday anxieties or depressions – is a very foreign experience; it’s hard to have compassion and empathy for something completely foreign to you. And it’s scary. We really want to believe that if children have problems, then their parents did something to cause their problems. The idea is that your parents screw you up – it’s hard-wired into us – so that when you hear about children with problems, your first thought is, “The mother must work too many hours” or “The parents are too competitive” or “They’re cold.” Of course, parents do have the ability to make their children happy or unhappy, but there is also a biological predisposition and temperament. The interplay between environment and what is inborn is a very important relationship. As I say in the book, the main paradigm for understanding the interplay of genes and environment now is “biology loads the gun, environment pulls the trigger.” But we want the narrative that explains it all away. We like to believe we can protect against this.

But we don’t know the long-term effects of these medications on brain development, right?

We do know that with all these drugs – SSRIs [selective serotonin reuptake inhibitors] included – there are side effects for the adults and children who take them. But you’re right in the long term, we don’t know. So this is part of the torture that parents go through in deciding to put their kids on medication.

What advice would you give parents who are trying to get appropriate care for their mentally ill children?

There are a lot of online communities for parents of children with various issues, and advocacy organizations like the National Alliance for the Mentally Ill where parents can get the help they’re entitled to. In public schools, for example, it’s a question of knowing how to work the system and what your rights are, who to talk to, how to stand up for your child, what forms to request, etc.

Pediatricians can also make recommendations for mental health specialists and can track the child over time. It’s important to have somebody else keeping an eye out, watching what works and doesn’t. But how many pediatricians, especially ones who accept health insurance, take that kind of time? The average pediatrician visit is 11 minutes. There has to be a way for longer visits to exist and be reimbursed.

So you would argue that children in fact are not being over-medicated?

Ninety five percent of American children are not being medicated at all. You might say, “Well 5% is still 1 in 20,” but that doesn’t make an argument for gross over-medication.

Look, nobody wants to stuff their kids full of chemicals. Nobody wants to interfere in ways that nobody understands with the growth of their kids’ brains. But for doctors who work with these kids and see how they suffer – and how limited their lives are – and then see how medication and therapy can bring these kids more of a full childhood, a “normal” life, one the child deserves to have – if we have that choice, why would we deprive children of those experiences?

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